Efficacy and Cost‐Effectiveness of Metformin - Real World Review.

<h2 id="background">Background</h2><ul><li>New drugs have been introduced in diabetes treatment over the past two decades which protects heart and kidney apart from their glucose-lowering efficacy.</li><li>Metformin retains a pivotal role among glucose-lowering agents despite these new opportunities.</li><li>Compelling real-world evidence in support of the clinical efficacy and cost effectiveness of metformin across different patient populations is presented here.</li></ul><h3 id="glucose-lowering-efficacy">1. Glucose Lowering Efficacy Of Metformin:</h3><ul><li>Metforminis one of the few available insulin sensitizers.</li><li>Metforminis an effective, safe, and overall well-tolerated drug backed by over 60 years of clinical experience.</li><li>This includes evidence for potential benefits beyond glucose reduction across different ages, sexes, genetic backgrounds, geographical areas, and stages of disease.</li><li>Metformin is an effective first-line option in newly diagnosed type 2 diabetes (T2D), and also remains a natural companion to all other glucose-lowering agents.</li></ul><h4>Age</h4><ul><li>Real-world observations show glucose-lowering efficacy of low-dose metformin to be similar in young adults and those aged 265 years.</li><li>Large observational study documented substantially higher adherence in patients older than 65 years with decreased discontinuation and increased adherence, across the age span.</li></ul><h3 id="tolerability-and-persistance">2. Tolerability And Persistance Of Metformin:</h3><p><strong>Tolerability and dose-dependent side effects:</strong></p><ul><li>The extended release (ER) formulation, allows the release of the active drug in the upper gastrointestinal tract, which improves its tolerability leading to increased persistence with therapy and the chances of reaching optimal full dosage.</li><li>Metformin ER reduces side effects, improves pill burden, therapeutic adherence, and patient satisfaction compared to metformin immediate release (IR).</li></ul><p><strong>Adherence and persistence across different populations:</strong></p><ul><li>In real-life settings, routine prescription of low starting doses of metformin, and use of ER formulations, help improve persistence on metformin therapy.</li><li>Real-world analysis of 60 327 adults with T2D reported metformin to have longest medication persistence among available glucose-lowering therapies.</li><li>A large observational prospective study (n = 19 600) performed from 2011 to 2019 showed medication adherence and persistence over a 3-year period which lead to better results in people with Diabetes (PwD).</li><li>National Health Insurance Research Database (NHIRD) of Taiwan shows Metformin adherence (n = 31 384) to be associated with reduced risk of incident CV disease irrespective of sex, age, and concurrent insulin treatment.</li></ul><h3 id="metformin-efficacy-on-mortality">3. Metformin Efficacy On Mortality And Cardiovascular Outcomes</h3><figure class="image"><img style="aspect-ratio:1060/531;" src="https://cdn.megawecare.com/GHBY/Internal-Images/metformin-efficacy-on-mortality%20.webp" width="1060" height="531"></figure><h3 id="cost-effectiveness">4. Cost Effectiveness Of Metformin As First-line Therapy</h3><ul><li>Metformin stands out as the most recommended and prescribed first-line therapy in Western countries, alone or in combination, not only due to its favourable efficacy and safety profile, but also for its affordability that allows widespread use without economic barriers.</li><li>Metformin comes at a very low cost, it has extremely high cost-effectiveness, particularly given the serious economic burden associated with diabetes complications.</li><li>This financial advantage is particularly relevant in resource-constrained healthcare systems, where the affordability of metformin may be instrumental in implementing an effective treatment in an ever growing number of individuals.</li></ul><h2 id="conclusion">Conclusion</h2><ul><li>Metformin has various RCTs, decades of clinical experience, and a growing evidence from real-world studies that consistently support the clinical and economic benefits of metformin, alone or in combination with other glucose-lowering therapies.</li><li>Metformin does not expose the patient to the risk of hypoglycaemia, and may delay disease progression and the need for more expensive interventions.</li><li>This study presents compelling real-world evidence in support of the clinical efficacy and cost effectiveness of metformin across different patient populations.</li><li>In low-income countries, the possibility to rely on cost-effective, safe, and reliable drugs such as metformin may continue offering the opportunity to reach a growing number of individuals in the earlier stage of disease.</li></ul>

Diabetes Update Issue 4 July 2024

<ul><li><a href="#background">Background</a></li><li><a href="#glucose-lowering-efficacy">Glucose Lowering Efficacy of Metformin</a></li><li><a href="#tolerability-and-persistance">Tolerability and Persistance of Metformin</a></li><li><a href="#metformin-efficacy-on-mortality">Metformin Efficacy on Mortality and Cardiovascular Outcomes</a></li><li><a href="#cost-effectiveness">Cost Effectiveness of Metformin as First-line Therapy</a></li><li><a href="#conclusion">Conclusion</a></li></ul><p>&nbsp;</p>